Man experiences symptoms of withdrawal from his home

Clonidine has been used for more than 40 years to treat high blood pressure. It has also been valuable in helping people manage symptoms associated with certain types of substance withdrawal.

Gaining an understanding about clonidine, its uses and its effects can help people make informed decisions about its use.

What Is Clonidine?

Clonidine (brand names Catapres-TTS and Kapvay) is an anti-hypertensive drug that has been used to manage high blood pressure for decades. Clonidine is described as a centrally acting alpha-agonist that stimulates alpha-adrenoreceptors in the brain stem. This means that clonidine activates pathways in the brain that are responsible for maintaining normal blood pressure throughout the body.

What Is Clonidine Used For?

Clonidine’s main effect is in reducing vascular resistance, which allows blood to flow throughout the body more easily. This can reduce hypertension and normalize blood pressure. If vascular resistance is reduced too much, however, dizziness and fainting may occur. Clonidine is effective in treating high blood pressure, especially in people who have not responded well to other anti-hypertensive drugs.

Clonidine is also approved in the U.S. to treat attention deficit hyperactivity disorder (ADHD) in children. It can also manage some symptoms associated with Tourette syndrome as well as pain associated with cancer.

Off-label uses for clonidine include management of post-traumatic stress disorder (PTSD), anxiety and insomnia. In addition, clonidine can help control hot flashes in menopausal women, relieve restless leg syndrome and prevent vascular migraine headaches.

Clonidine can also relieve symptoms associated with detox and withdrawal from opioid use disorders. However, it is less effective in treating alcohol or benzodiazepine withdrawal symptoms. In recent years, clonidine has largely been replaced by other drugs that are more effective in managing withdrawal symptoms.

Using Clonidine for Withdrawal and Detox

Clonidine has been successful in managing uncomfortable symptoms associated with detox and withdrawal from opioids like heroin, benzodiazepines and alcohol. The medication is used to treat withdrawal symptoms in a few different ways.

Clonidine for Heroin Withdrawal

Heroin is a powerfully addictive illicit opioid that is associated with incredibly uncomfortable withdrawal symptoms. Because heroin has a very short half-life, withdrawal symptoms set in very quickly after the last use and cause strong cravings that can be difficult to manage alone.

Clonidine is especially useful for heroin withdrawal of moderate severity when it is combined with medications that treat other symptoms. For example, other medications are used to treat nausea and vomiting, diarrhea, insomnia, anxiety and other common withdrawal symptoms. However, clonidine is not generally given at the same time as opioid replacement therapies, such as buprenorphine or methadone. Vitamin B and vitamin C supplements are also used with clonidine treatment for heroin withdrawal.

Severe heroin withdrawal is best addressed with opioid replacement therapies like buprenorphine or methadone. These drugs are better able to address the chemical dependence caused by heroin.

Clonidine for Alcohol Withdrawal

Alcohol use disorders are associated with potentially dangerous withdrawal symptoms, including seizures and delirium tremens. The first-line treatment for alcohol withdrawal is benzodiazepines.

Clonidine has been used to help people manage alcohol withdrawal symptoms, but it is typically administered along with a sedative or benzodiazepine. Clonidine alone is generally not enough to control the potentially dangerous symptoms of moderate to severe alcohol withdrawal.

Clonidine for Opioid Withdrawal

Buprenorphine is the current gold standard for medication-assisted therapy for opioid use disorders. It is typically provided under the brand name Subutex or, when naloxone is included, Suboxone. A recent study showed that when patients with opioid withdrawal symptoms were provided with either clonidine or buprenorphine, those who took buprenorphine were more likely to be in recovery treatment one month later. These results indicate that buprenorphine is more effective at helping people stay in recovery in the first month after quitting opioids.

These preliminary findings do not mean that clonidine has no role in treating opioid use disorders. Many emergency departments continue to successfully administer clonidine to incoming patients. However, the data suggests that switching clients from clonidine to buprenorphine may increase recovery success rates.

Clonidine for Benzo Withdrawal

Clonidine has been used occasionally in recent decades to help people manage detox and withdrawal symptoms related to benzodiazepine use. However, recent studies have not found clonidine to be an effective treatment for people struggling with benzo withdrawal.

Administration of Clonidine for Drug or Alcohol Detox

Clonidine can be administered in several ways, including:

  • Transdermal patch, which provides a consistent dose of clonidine over the course of seven days. This method is very common for people facing withdrawal symptoms.
  • Immediate-release tablets, which are often used to help people with opioid withdrawal symptoms.
  • Extended-release tablets, which are used less frequently to help people manage withdrawal symptoms.
  • Injectable solutions, which are rarely used in people suffering from withdrawal symptoms.

Each of these formulations comes in several doses. The specific clonidine withdrawal dosing depends on the specific circumstances, but target doses for treating opioid withdrawal symptoms are typically between 0.1 mg and 0.3 mg per day.

Clonidine Side Effects

Clonidine is associated with a number of potential adverse effects, but they tend to become less severe with continued use. Commonly reported side effects of clonidine use include:

  • Sedation
  • Dizziness
  • Headache
  • Fatigue
  • Nausea
  • Diarrhea
  • Sexual dysfunction
  • Abdominal pain
  • Anxiety
  • Mood swings
  • Dry mouth

Less common but more serious side effects may include:

  • Depression
  • Slow heart rate
  • Severe hypotension (characterized by fainting or extreme dizziness)
  • Swelling, often around the face or lips but sometimes in other parts of the body

Clonidine Drug Interactions

Clonidine is generally well tolerated. However, there are some drugs that should not be taken with clonidine due to the potential for drug interactions:

  • Central nervous system depressants (alcohol, benzodiazepines, opioids, barbiturates or other drugs that have a sedating effect)
  • Beta-blockers
  • Calcium channel blockers
  • Amitriptyline
  • Tricyclic antidepressants

Safe Medical Detox Using Clonidine for Withdrawal

While more modern medications have largely replaced clonidine, clonidine is still helpful in relieving the severity of some withdrawal symptoms. It is especially helpful for mild to moderate withdrawal symptoms that are associated with heroin or opioid use disorders.

Clonidine is generally safe when taken as prescribed. However, there is some risk for the development of dependence if it is misused. Overdose is also possible, though it is generally not associated with long-term damage or fatalities. People taking clonidine should follow the direction of a medical professional and adhere to the prescribed dose and dosing frequency.

If you or someone you love is struggling with a substance use disorder, help is available. The  Orlando Recovery Center is able to help people successfully overcome the first days of detox and withdrawal. We also offer high-quality residential and outpatient treatment programs that help patients succeed in long-term recovery. Contact us today to learn more about plans and programs that can work well for you.

Sources

Yasaei, Rama; Saadabadi, Abdolreza. “Clonidine.” NCBI StatPearls, October 2019. Accessed October 28, 2019.

U.S. Food and Drug Administration. “Catapres (clonidine hydrochloride) Prescribing Information.” October 2009. Accessed October 28, 2019.

World Health Organization. “Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.” 2009. Accessed October 28, 2019.

Hoffman, Robert S; Weinhouse, Gerald L. “Management of moderate and severe alcohol withdrawal syndromes.” Up To Date, September 2019. Accessed October 28, 2019.

Srivastava, Anita; et al. “Buprenorphine in the emergency department: Randomized clinical controlled trial of clonidine versus buprenorphine for the treatment of opioid withdrawal.” Canadian Family Physician, May 2019. Accessed October 28, 2019.

Fluyau, Dimy; Revadigar, Neelambika; Manobianco, Brittany E. “Challenges of the pharmacological management of benzodiazepine withdrawal, dependence, and discontinuation.” Therapeutic Advances in Psychopharmacology, February 2018. Accessed October 28, 2019.

Medical Disclaimer: Orlando Recovery Center aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.